First large studies of web-based population care tool helped doctors improve diabetes, CV care

A web-based tool that extracts information from electronic medical records may help primary care physicians improve care and manage their entire panel of patients with diabetes and cardiovascular disease.

Those are the findings of two new studies conducted at Kaiser Permanente, the first to examine the effectiveness of a population care tool in a large, diverse patient population.

Developed and implemented at Kaiser Permanente, the Panel Support Tool is a web-based tool that helps primary care physicians manage care for individual patients, groups of patients or their entire panel. It compares the care the patient is receiving with care that is recommended by national guidelines. Physicians can query the Panel Support Tool in advance of a patient visit to determine if the patient needs a screening test or vaccine. Or, the physician can use the Panel Support Tool to display a list of all patients who are overdue for a mammogram or cancer screening test or a list of patients with diabetes whose blood glucose levels are too high, according to a press release.

“Patients in the United States receive only about half of the preventive and follow-up care now recommended by national guidelines. Our study shows that, by using the innovative Panel Support Tool, in conjunction with the electronic medical record, we can provide patients with more of the care they are supposed to receive,” Adrianne Feldstein, MD, MS, senior investigator at Kaiser Permanente Center for Health Research, Portland, OR, said in the release.

Improved care

In the first study, published in the American Journal of Managed Care, Feldstein and colleagues conducted a retrospective, longitudinal study and followed 204 primary care teams who used the Panel Support Tool to manage care for more than 48,000 patients with diabetes and/or CVD. After 3 years, the percentage of care recommendations met every month by patients with diabetes increased from 67.9% to 72.6%; for patients with CVD, the percentage rose from 63.5% to 70.6%. Care recommendations measured included blood glucose levels; blood pressure screening and control; retinopathy; foot screening; use of aspirin, statins, angiotensin-converting enzyme inhibitors and beta blockers; and influenza and pneumococcal vaccination.

The second study, which was published in Population Health Management, involved 207 primary care teams that were using the Panel Support Tool to manage the care of more than 263,000 adult patients. Researchers evaluated 13 different care recommendations. They found that after 20 months, the Panel Support Tool improved performance from 72.9% to an average of 80%. During the first year of use, performance in delivering care recommendations improved to a statistically significant degree every 4 months.

Benefits of a web-based tool

The Panel Support Tool monitors recommendations for medication management and screening for comorbidities in six chronic conditions: diabetes; coronary artery disease; hypertension; chronic kidney disease; heart failure; and asthma. The tool also monitors preventive care measures, including administration of adult immunizations and screening for cancer, hyperlipidemia and osteoporosis.

At Kaiser Permanente, the Panel Support Tool extracts data from data repositories and automatically updates all patient-level and panel views once a day. When patients obtain needed screening or lab tests or fill prescriptions, the Panel Support Tool reflects that activity the next day, according to information in the release.

More research is needed to optimize results and determine if patient outcomes improve with improved care delivery.

However, the researchers cautioned that the Panel Support Tool should not override shared decision making between the doctor and patient.

Both studies will be published in the October issues of the American Journal of Managed Care and Population Health Management.

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